HumanaOne – Individual Dental & Vision Plans

Dental Plan C550

Our Rating:

With the HumanaOne Dental Plan C550 (formerly CompBenefits Plan 550), you won’t be surprised by any hidden costs. There just aren’t any. Your dental needs are covered right from the start. Any pre-existing condition you may have is covered immediately and the plan can be purchased on a standalone basis without a Humana health insurance plan.

The HumanaOne Pre-Paid Dental Plan C550 gives you access to services with low co-payments through a wide network of dentists. This is a great plan for individuals who want:

No co-payments on many diagnostic and preventive procedures

Confidence that you will save money on dental care.

No benefit maximums

HumanaOne Dental Plan C550 (Formerly CompBenefits C550)

Plan Features

100% coverage on many diagnostic and preventive procedures. You pay nothing for this dental work.

Low $10 office visit co-payment

Discounts on Specialty Care and certain Cosmetic Procedures

No benefit maximum or claim forms

A provider network with more than 5,000 network dentists

Specialty care and some cosmetic procedures covered at a discount

How it Works

First, sign up for coverage. When you are filling in your application you will need to select your Primary Care Dentist from the dental directory list. Participating dentists are located near your home or office. Each dentist is licensed and is a skilled and experienced professional. CompBenefits carefully reviews the credentials of each dentist in the network before they are selected. Family members under the same plan may select different dentists. You can find a dentist by visiting Humana’s Dentist Finder.

When you see your participating dentist, you’ll receive no charge services on

Complete Procedure Price List

Appointments

Consultation (diagnostic service provided by dentist other than practitioner providing treatment).

$30.00

D9430

Office visit (normal hours)

$10.00

D9440

Office visit (after regularly scheduled hours)

$35.00

D9999

Emergency visit during regularly scheduled hours, by report.

$20.00

D9999

Broken appointments (without 24 hr. notice, per 15 min) -maximum $40 per broken appointment. No charge will be made due to emergencies

$10.00

Code

Diagnostic

Member Pays

D0120

Periodic oral examination

no charge

D0140

Limited/comprehensive/detailed and extensive oral eval

no charge

D0150

Limited/comprehensive/detailed and extensive oral eval

no charge

D0160

Limited/comprehensive/detailed and extensive oral eval

no charge

D0180

Comprehensive periodontal evaluation

$25.00

D0210

X-ray intraoral-complete series including bitewings

no charge

D0220

X-ray intraoral-periapical, first film

no charge

D0230

X-ray intraoral-periapical, each additional film

no charge

D0270

X-ray bitewing-single film

no charge

D0272

X-ray bitewings-two films

no charge

D0274

Bitewings-four films

no charge

D0330

Panoramic film

no charge

D0460

Pulp vitality tests

no charge

D0470

Diagnostic casts

no charge

Code

Preventive

Member Pays

D1110

Prophylaxis-adult, routine (once every 6 months)

no charge

D1120

Prophylaxis-child, routine (once every 6 months)

no charge

D1110

Prophylaxis-adult/child, (additional)

$35.00

D1120

Prophylaxis-adult/child, (additional)

$35.00

D1203

Topical application of fluoride (not including prophylaxis)â€” child (up to 16 years of age)

no charge

D1206

Topical fluoride varnish (for child <16)

no charge

D1330

Oral hygiene instruction

no charge

D1351

Sealant-per tooth

$20.00

D1510

Space maintainer-fixed, unilateral

$65.00 + lab

D1515

Space maintainer-fixed, bilateral

$65.00 + lab

D1520

Space maintainer-removable, unilateral

$105.00 + lab

D1525

Space maintainer-removable, bilateral

$105.00 + lab

D1550

Recementation of space maintainer

$20.00

Code

Restorative

Member Pays

D2140

Amalgam-one surface, primary or permanent

$30.00

D2150

Amalgam-two surfaces, primary or permanent

$35.00

D2160

Amalgam-three surfaces, primary or permanent

$40.00

D2161

Amalgam-four or more surfaces, primary or permanent.

$50.00

D2940

Sedative filling

$30.00

D2999

Sedative base (under fillings), by report

no charge

Code

Resin Restorative

Member Pays

D2330

Resin based composite-one surface, anterior

$50.00

D2331

Resin based composite-two surfaces, anterior

$55.00

D2332

Resin based composite-three surfaces, anterior

$65.00

D2391

Resin based composite-one surface, posterior

$90.00

D2392

Resin based composite-two surfaces, posterior

$110.00

D2393

Resin based composite-three surfaces, posterior

$130.00

D2394

Resin based composite-four or more surfaces, posterior

$150.00

D2510

Inlay-metallic, one surface

$155.00

D2520

Inlay-metallic, two surfaces

$165.00

D2530

Inlay-metallic, three or more surfaces

$190.00

Code

Crown and Bridge

Member Pays

D2740

Crown-porcelain/ceramic substrate

$370.00 + lab

D2750*

Crown-porcelain fused to high noble metal

$370.00

D2751

Crown-porcelain fused to predominantly base metal

$370.00

D2752*

Crown-porcelain fused to noble metal

$370.00

D2790*

Crown-full cast high noble metal

$370.00

D2791

Crown-full cast predominantly base metal

$370.00

D2792*

Crown-full cast noble metal

$370.00

D2910

Recement inlay

$30.00

D2920

Recement crown

$30.00

D2930

Prefabricated stainless steel crown-primary tooth

$120.00

D2950

Core buildup, including any pins

$60.00

D2951

Pin retention-per tooth, in addition to restoration

$30.00

D2952

Cast post and core in addition to crown

$120.00 + lab

D2953

Each additional cast post-same tooth

$120.00 + lab

D2954

Prefabricated post and core in addition to crown

$120.00

D2962

Labial veneer (porcelain laminate)â€”laboratory

$370.00 + lab

Code

Endodontics

Member Pays

D3220

Therapeutic pulpotomy

$50.00

D3221

Pulpal debridement, primary and permanent teeth

$130.00

D3310

Root canal therapy-anterior (excluding final restoration)

$250.00

D3320

Root canal therapy-bicuspid (excluding final restoration)

$350.00

D3330

Root canal therapy-molar (excluding final restoration)

$450.00

D3410

Apicoectomy/periradicular surgery-anterior

$200.00

Code

Peridontics (gum treatment)

Member Pays

D4210

Gingivectomy/gingivoplasty per quadrant

$200.00

D4211

Gingivectomy/gingivoplasty per tooth

$55.00

D4341

Periodontal scaling and root planing, per quadrant

$65.00

D4342

Periodontal scaling and root planing 1 to 3 teeth per quadrant

$65.00

D4355

Full mouth debridement to enable comprehensive evaluation and diagnosis

$60.00

D4381

Localized delivery of chemotherapeutic agents (per tooth)

$60.00

D4910

Periodontal maintenance

$65.00

Code

Prosthodontics

Member Pays

D5110

Complete denture-maxillary

$375.00+lab

D5120

Complete denture-mandibular

$375.00+lab

D5130

Immediate denture-maxillary

$375.00+lab

D5140

Immediate denture-mandibular

$375.00+lab

D5211

Maxillary partial denture-resin base

$375.00+lab

D5212

Mandibular partial denture-resin base

$375.00+lab

D5213

Maxillary partial denture-cast metal framework, resin denture bases

$375.00+lab

D5214

Mandibular partial denture-cast metal framework, resin denture bases

$375.00+lab

D5410

Adjust complete denture-maxillary

$30.00

D5411

Adjust complete denture-mandibular

$30.00

D5421

Adjust partial denture-maxillary

$30.00

D5422

Adjust partial denture-mandibular

$30.00

Code

Repairs to prosthetics

Member Pays

D5510

Repair broken complete denture base

$30.00+lab

D5520

Replace missing or broken teeth-complete denture (each tooth)

$30.00+lab

D5610

Repair resin denture base

$30.00+lab

D5630

Repair or replace broken clasp

$30.00+lab

D5640

Replace broken teeth-per tooth

$30.00+lab

D5650

Add tooth to existing partial denture

$45.00+lab

D5730

Reline complete maxillary denture (chairside)

$65.00

D5731

Reline complete mandibular denture (chairside)

$65.00

D5740

Reline maxillary partial denture (chairside)

$65.00

D5741

Reline mandibular partial denture (chairside)

$65.00

D5750

Reline complete maxillary denture (laboratory)

$50.00+lab

D5751

Reline complete mandibular denture (laboratory)

$50.00+lab

D5760

Reline maxillary partial denture (laboratory)

$50.00+lab

D5761

Reline mandibular partial denture (laboratory)

$50.00+lab

D5850

Tissue conditioning-maxillary

$45.00

D5851

Tissue conditioning-mandibular

$45.00

Code

Prosthodontics (fixed)

Member Pays

D6210*

Pontic-cast high noble metal

$370.00

D6211

Pontic-cast predominantly base metal

$370.00

D6212*

Pontic-cast noble metal

$370.00

D6240*

Pontic-porcelain fused to high noble metal

$370.00

D6241

Pontic-porcelain fused to predominantly base metal

$370.00

D6242*

Pontic-porcelain fused to noble metal

$370.00

D6750*

Crown-porcelain fused to high noble metal

$370.00

D6751

Crown-porcelain fused to predominantly base metal

$370.00

D6752*

Crown-porcelain fused to noble metal

$370.00

D6790*

Crown-full cast high noble metal

$370.00

D6791

Crown-full cast predominantly base metal

$370.00

D6792*

Crown-full cast noble metal

$370.00

D6930

Recement fixed partial denture (per unit)

$25.00

Code

Extractions/oral and maxillofacial surgery

Member Pays

D7111

Coronal remnants, deciduous tooth

$35.00

D7140

Extraction, erupted tooth or exposed tooth

$35.00

D7210

Surgical removal of erupted tooth

$55.00

D7220

Removal of impacted tooth-soft tissue

$100.00

D7230

Removal of impacted tooth-partially bony

$125.00

D7240

Removal of impacted tooth-completely bony

$150.00

D7250

Surgical removal of residual tooth roots

$65.00

D7310

Alveoloplasty in conjunction with extractions-per quadrant

$65.00

D7311

Alveoplasty in conjunction with extractions-one to three teeth or tooth spaces, per quadrant

$65.00

D7320

Alveoloplasty not in conjunction with extractions-per quadrant

$100.00

D7321

Alveoplasty not in conjunction with extractions-one to three teeth or tooth spaces, per quadrant

$100.00

D7510

Incision and drainage of abscess-intraoral

$40.00

Code

Anesthesia

Member Pays

D9215

Local anesthesia

no charge

D9230

Analgesia (nitrous oxide), per 15 minutes

$30.00

Code

Adjunctive general services

Member Pays

D9450

Case presentation, detailed and extensive treatment planning

no charge

D9951

Occlusal adjustment-limited

$40.00

D9952

Occlusal adjustment-complete

$225.00

Orthodontics

NOTE: Members can receive a 25 percent savings by visiting an in-network orthodontist.

* The above copayments do not include the additional cost of precious (high noble) and semi-precious (noble) metal. The additional cost of precious metal shall not exceed $125 per unit and $75 per unit for semi-precious metal.

NOTE:

NOT ALL PARTICIPATING DENTISTS PERFORM ALL LISTED PROCEDURES, INCLUDING AMALGAMS. PLEASE CONSULT YOUR DENTIST PRIOR TO TREATMENT FOR AVAILABILITY OF SERVICES.

UNLISTED PROCEDURES ARE AT THE DENTIST’S USUAL FEE LESS 25 percent INCLUDING, BUT NOT LIMITED TO, MAXILLOFACIAL PROSTHETICS, ENAMEL MICROABRASION, AND BLEACHING.

WHEN CROWN AND/OR BRIDGEWORK EXCEEDS SIX UNITS IN THE SAME TREATMENT PLAN, THE PATIENT MAYBE CHARGED AN ADDITIONAL $50.00 PER UNIT.

Waiting Periods on Types of Services

Preventive

None

Diagnostic

None

Basic

None

Major

None

Preventive care

Routine oral exams

Prophylaxis (cleaning and scaling of teeth) – two per year

Topical fluoride application (up to age 16 and not including prophylaxis) â€“ two per calendar year

Diagnostic care

Intra-oral occlusal film

Bitewing X-rays (up to a set of four)

Full-mouth X-rays (panoramic film)

Endodontics care

Root canal therapy

Pulpal debridement, primary and permanent teeth

Apexification/recalcification

Apicoectomy/periradicular surgery

Periodontics care

Gingivectomy/gingivoplasty

Osseous surgery

Pedicle/free soft tissue grafts

Periodontal scaling and root planing

Orthodontia

NOTE: Members can receive a 25 percent savings by visiting an in-network orthodontist.

Plan C550 Rates

Fee

Price

One-Time Enrollment Fee

$35.00 (total)
The fee for both 1 person or 4 persons is $35.

Monthly Premium (1 person)

$14.18

Monthly Premium (2 persons)

$23.50

Monthly Premium (3 persons)

$31.52

Monthly Premium (4 persons)

$39.37

Monthly Admin Fee
(Included in rates above, waived if you pay yearly)

$1.00

Effective Dates

DHMO (Dental C550) effective dates are calculated as follows:

If application is received between the 1st and 15th of the month, the policy effective date will be the 1st of the following month 1. Example: Application received on May 10th will have an effective date of June 1st.

If application is received between the 16th and end of the month, the policy effective date will be the 1st of the 2nd following month (the month after the following month) 1. Example: Application received May 18th for processing will have a policy effective date of July 1st.

The reason for the difference in effective dates is due to the member having to select a primary care dentist and being included in the monthly membership rosters sent to providers.

Can I Terminate My Coverage At Anytime?

No, there is a one year contract with these plans. However, Dental C550 members can terminate their coverage within the first 30 days of their effective date, but they will only be refunded their premium (not enrollment fee) and will be responsible for any claims incurred during this time. After the 30 day window, cancellations are not accepted unless for approved exceptions.

Payment Options

After Enrollment

After enrollment, members will receive a welcome packet and ID cards 7-10 days after the application is received and enrollment is processed, and should bring their ID cards with them when visiting the dentist. Members should inform their provider of their plan when scheduling their appointment to avoid any issues at the time of service.

Preventive Plus Plan

If you’re looking for a dental PPO plan, this one is low-cost and provides coverage for preventive care, such as cleanings and X-rays, and offers discounts on basic and major services. Plus, there are no copayments for office visits.

With the Preventive Plus plan, you can choose to visit any dentist in the Humana dental network. There are more than 120,000 in-network dentists nationwide to choose from. Even though you have the option of paying monthly or yearly, this is a one year plan.

Humana Preventive Plus Plan Highlights include:

100% coverage for preventive services

No waiting period for preventive services; six month wait for basic services

Freedom to Choose Any Dentist

$1,000 annual maximum per person per year

No exclusions for pre-existing conditions

Available for all ages including seniors over 65

Plan Features

Plan features include:

No copayments for office visits

Annual Deductibles: $50 for an individual, $100 for a two person plan, $150 for a family

With in-network providers, many basic services are covered 50 percent and you get a discount on most major services

No waiting period for preventive services; 6 month wait for basic services

$1,000 annual maximum per person per year

No exclusions for pre-existing conditions

Freedom to visit any provider, no primary care dentist required

Benefit Summary

Plan Feature

In-Network

Out-of-Network

Deductible

$50 individual / $150 family

Annual Maximum Benefit

$1,000 per person

Preventive Care – No waiting period

Oral exams

Routine cleanings

X-rays

Sealants

Topical flouride treatment

100% (no deductible)

70% of in-network fee schedule after deductible

Basic Services – 6 month waiting period

Emergency Care for Pain Relief

Extractions and root removal

Space Maintainers

Fillings (amalgam, composite foranterior teeth)

Oral Surgery

Prefabricated Stainless Steel Crowns

50% after deductible

30% of in-network fee schedule after deductible

Discount Services – no waiting period

Endodontics (root canals)

Periodontics (gum disease)

Crowns

Inlays and Onlays

Bridgework

Dentures

Denture Relines/Rebases

Adult and child Orthodontia

Receive an average discount of 28% by seeing in-network dentists.

Not available

Procedure Prices

Dental Services

Coverage Level

Routine Evaluation

100%

Routine Cleanings

100%

X-rays

100%

Extractions

50% after deductible

Oral Surgery

50% after deductible

Fillings

50% after deductible

Preventative Plus Rates

Fee

Price

One-Time Enrollment Fee

$35.00 (total)
The fee for both 1 person or 4 persons is $35.

Monthly Premium (1 person)

$21.99

Monthly Premium (2 persons)

$42.23

Monthly Premium (3 persons)

$64.47

Each additional dependent under 22

$22.24 per month

Each additional dependent over 22

$20.24 per month

Admin Fee
(Included in rates above, waived if you pay yearly)

$1.00

Monthly Association Fee (PBA)
(Included in rates above)

$0.75

Effective Dates

Dental Preventive Plus effective dates are calculated as follows:

Regardless of when an application is received for these plans, the policy will have an effective date of the 1st of the following month.

Example: Application received on May 10th will have an effective date of June 1st.

If application is received between the 16th and end of the month, the policy effective date will be the 1st of the 2nd following month (the month after the following month).

Example 1: Application received May 18th for processing will have a policy effective date of July 1st.

Example 2: Application received on May 31st will have an effective date of June 1st.

Can I Terminate My Coverage At Anytime?

No, there is a one year contract with these plans. However, Dental Preventive Plus, Vision Care Plan and Vision Focus Plan members can terminate their coverage within the first 10 days of their effective date, but they will only be refunded their premium (not enrollment fee) and will be responsible for any claims incurred during this time. After the 10 day window, cancellations are not accepted unless for approved exceptions.

Payment Options

After Enrollment

After enrollment, members will receive a welcome packet and ID cards 7-10 days after the application is received and enrollment is processed, and should bring their ID cards with them when visiting the dentist. Members should inform their provider of their plan when scheduling their appointment to avoid any issues at the time of service.

Vision Plan

Our Rating:

Humana’s individual vision insurance plan can help you save money on eye exams, eyeglass lenses and frames, and contacts. It also offers substantial discounts on LASIK and cosmetic extras. Here are more of the plan’s features:

The Humana Vision Plan can be added to your medical plan and is also available for individuals and families on a standalone basis. There is no underwriting, which means you will not be disqualified for pre-existing conditions. It only takes a minute to sign up online. Once you’re enrolled, you only pay $10 copayment for your annual examination and can visit any eye doctor in the VCP Network.

How Does Wholesale Frame Allowance Work?

Benefits include a wholesale frame allowance. If the wholesale cost exceeds the frame allowance, members pay twice the wholesale difference. They never pay full retail.

Retail Price

Wholesale Price

Wholesale Allowance

Member Pays

Savings

$80-$120

$40

$40

$0

$80-$120

$140-$210

$70

$40

$60
($70-$40=$30 x 2=$60)

$80-$150

Lasik and PRK Procedures

Members receive substantial reductions when procedures are done by network providers. Members can expect to pay no more than $1,800 per eye for conventional Lasik procedures and $2,300 per eye for custom Lasik from network providers. Members also receive benefits on services performed by preferred TLC Select Lasik Plan providers at the following fixed prices:.

Lasik Package

Cost

Silver Package

$895 per eye for Conventional Lasik

Gold Package

$1,295 per eye for CustomLasik, TLC Lifetime Commitment can be purchased for $200 per eye

Platinum Package

$1,895 per eye for CustomLasik plus Bladeless Lasik (using IntraLase technology). Includes the TLC Lifetime Commitment. PRK is available on this package only

Effective Dates

Vision effective dates are calculated as follows:

If application is received between the 1st and 15th of the month, the policy effective date will be the 1st of the following month. 1. Example: Application received on May 10th will have an effective date of June 1st.

If application is received between the 16th and end of the month, the policy effective date will be the 1st of the 2nd following month (the month after the following month). 1. Example: Application received May 18th for processing will have a policy effective date of July 1st.

Payment Options

People’s Benefit Alliance Membership

Membership in the People’s Benefit Alliance (PBA) is required at additional cost (your $0.75 association fee covers this) in order to be eligible to apply for this plan. With your membership, you will receive discounts on health, travel, consumer, and business-related services, such as:

Fitness Programs- Puts benefits for healthier living within reach for you and your family

Vitamin Discounts- Offers discounts on an extensive selection of vitamins

Car Rental Discounts- Get great deals on car rentals

The association is a membership organization that provides educational information and discounts on goods and services to its members.